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Ventricular performance in long-term survivors after Fontan operation
Yuki Nakamura1, Toshikatsu Yagihara, Koji Kagisaki
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan. finitoyuki@msn.com
The Annals of Thoracic Surgery
|December 22, 2010
Summary
Long-term Fontan circulation follow-up shows steady ventricular function but increased ventricular tachycardia risk after 15 years, particularly in older patients. Age at surgery and absolute age are key risk factors.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Long-term ventricular function and arrhythmia in Fontan circulation patients remain poorly understood.
- The Fontan operation is a palliative procedure for complex single-ventricle congenital heart defects.
Purpose of the Study:
- To evaluate long-term ventricular function and arrhythmia in patients with Fontan circulation.
- To identify risk factors for adverse events in the late postoperative period.
Main Methods:
- Retrospective review of 48 patients with >15 years follow-up after Fontan operation (1979-1992).
- Categorization into atriopulmonary (APC) and total cavopulmonary connection (TCPC) groups, and ventricle types (RV, LV, biventricular).
- Serial cardiac catheterization and exercise testing every 5 years; multivariate analysis for risk factors.
Main Results:
- TCPC group showed higher cardiac index than APC group at 10 and 15 years.
- Left ventricle group had higher ejection fraction than right ventricle group.
- Ventricular tachycardia developed in 6 patients >15 years post-op; older age at Fontan operation and absolute age were significant risk factors.
Conclusions:
- Postoperative ventricular systolic performance appears to stabilize in the long term.
- Ventricular tachycardia is a significant long-term complication, with age-related risk factors identified.
- Further consideration of age as a risk factor for late ventricular arrhythmias in Fontan patients is warranted.
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